Dr. Rony Brauman, former president of Doctors Without Borders/Médecins Sans Frontières (MSF) in France and research director of MSF Foundation, recently returned from Southern Sudan, where he visited the new capital Juba as well as MSF programs in Akuem and Bentiu. He describes the situation nearly two years after the Sudanese government and the Southern Peoples' Liberation Movement (SPLM) signed a Comprehensive Peace Agreement (CPA), and also raises questions about the position aid organizations have taken in the context of reconstruction.

In January 2005, after 20 years of war interrupted occasionally by short-lived ceasefires, the south Sudan rebels and Sudanese government signed a peace agreement. It took three years of negotiations, sponsored and guided by the U.S. government, to reach a compromise acceptable to both parties. Trust is hardly to be expected among former warring parties, particularly in a country so deeply wounded by an endless history of violence. Indeed, the human cost of the war has yet to be determined: One million people, perhaps more, have died, and three to four million have been displaced, most of around the capital city, Khartoum. These numbers begin to describe the disaster from which Southern Sudan is emerging and the problems that await it.

However, Juba, the southern political and administrative capital, is not in mourning. The city is very much alive. A match has been scheduled between two local soccer teams and their respective supporters spill out into the streets, wearing team jerseys, blowing whistles and waving flags. We could be in Nantes or Manchester. Shops and restaurants have multiplied, the markets are well-stocked and crowded and the bus stations are teeming. That is all as it should be. The city's population has doubled in a year, so merchants are pleased, but housing has not kept pace and rents have skyrocketed.

Humanitarian Agencies Have a Massive and Visible Presence

The massive international presence is visible as soon as your plane touches down and you set foot in the Juba international airport. More than 10 huge white trucks bearing the logos of various U.N. agencies are parked outside. Everyone is here: from the World Food Program (WFP) to UNICEF, the UN High Commission for Refugees to the World Health Organization (WHO), as part of the United Nations Mission in Sudan (UNMIS), a major deployment of 6,000 Blue Helmets and 4,000 civilians. They have been assigned to back up the peace accord, and, more specifically, to support the integration of rebel forces and the regular army, to help refugees return home, to participate in protecting civilians and to restore part of the road system.

Dozens of NGOs and government aid agencies are here, too, based in Juba and operating throughout the South. Hospitals, schools, roads and bridges have been rebuilt, thanks in part to aid groups and, also, to oil companies (primarily Chinese) that are prospecting and drilling in the major oilfields located on the edge of both the North and South. However, these projects constitute only a small share of a huge undertaking, most of which remains to be carried out.

The new government authorities must organize a power-sharing arrangement among the movements that fought in the war or that have substantial forces at their disposal. These talks are tense, particularly when long-serving combatants are pushed aside in favor of past enemies because of political expediency. The authorities are also working, as best they can, to establish a non-existent administration in the ten states that form the new South. The distribution of jobs is, naturally, the subject of difficult negotiations.

Nonetheless, everything remains to be (re)built from scratch. This is the program to which NGOs have been invited to contribute. Some have already gotten down to the job. Norwegian People's Aid (NPA) flags and stickers are visible on many public buildings and an endless fleet of vehicles. This large NGO decided to serve as the Juba government's intermediary for a range of functions, from de-mining to rebuilding hospitals, supporting the press and providing professional training. This is a paradoxical choice for a non-governmental organization. Where is the "nongovernmental" in that role? However, it is a respectable position because it is being done openly.

Reconstruction Through the Aid System Is An Illusion

Despite appearances, however, NGOs and the United Nations cannot serve as subcontractors for the enormous reconstruction project facing the South Sudanese. Public goods–health, education and other community facilities–cannot be cobbled together from piecemeal contributions from aid organizations, whether private or U.N.-based. These groups have neither the mandate nor the means to become the government's human resources agency or its operational administrators. The government would be unable to orchestrate such a disparate collection, with its host of constraints and diverse skills–and not only for lack of resources. Rather, the more important reason is that it is impossible to coordinate a group of heterogeneous institutions. These are not temporary employment agencies. It is also impossible to exercise real authority over them. However, this illusion that the international aid system will carry out reconstruction seems to be one of the most widely-held beliefs in South Sudan.

It calls to mind the unrealistic statements issued by the same actors after the tsunami. One might well suggest that the country consider recruiting the managers it needs from today's very open international labor market. Such an approach would certainly be more expensive but thanks to oil income and outside aid, government coffers are not empty–not by a long shot.

Adapting Our Programs to This New Context

Does this mean that aid organizations are no longer necessary? Certainly not. They provide a range of services and will continue to be useful in supplementing government activities. MSF has not yet determined what form our activity will take. However, it is already clear that we must avoid the trap of involvement in public health systems, despite their deficiencies. The government and the WHO would very much like us to respond to chronic and acute epidemics, given our expertise in this area. That is where we can provide concrete assistance, particularly because it would involve adapting and refocusing existing programs. Regardless, we will have to make major changes to those programs as they are no longer appropriate to the population's needs.

As mentioned above, the political context has, indeed, changed. And even though peace is the order of the day, the future remains unclear. Hatreds and resentments have not disappeared, violent incidents are frequent, oil income stirs up envy, and the various armed forces throughout the South have not been integrated. In short, the political outcome of the peace accords is unknown. Critical points are already on the horizon, including the census and elections in 2007 and the referendum in 2011. Violent flare-ups–and worse–could occur, but as of now, there is no way to know what course events will take. This uncertainty alone is hardly a reason to remain in South Sudan because humanitarian aid focuses on today, not on the future. But it does offer one more reason. Let's hope that this one remains in the realm of the hypothetical.